titration study results - what does this mean?

[ltd123]

Here is the data: if it helps... I can not go to sleep at these studies without Ambien...
time in bed 404 min
total sleep 293 min
sleep efficiency 72 %
sleep latency 34 min
Rem latency 112 min
total wake time 111 min
stage I 12 %
stage II 63 %
stage III/IV 7 %
stage Rem 17 %
apnea/hypopnea index < 1 per hr at 10/6 cm

ECG usual heart rate wake 56 sleep 56 rhythm normal sinus
EEG -frequent arousals during sleep occurring with changes in respiration, plm and without clean precipitant. Amount stage 1 sleep mildly elevated from normal. The arousal index was 24 per hour. Sleep efficiency was reduced by a prolonged sleep latency and awakenings during the study.

Respiration - wake rate 8 sleep rate 16. Bipap was initiated at ipap 9 epap 6 and titrated to 10 / 6. At 10 /6 sleep and respiration were improved and AHI reduced to < 1 per hr (AHI 13 per hour 6/06 (my original sleep study with no mask)
At This pressure, O2 saturation was maintained > 90%.

EMG frequent increases in muscle activity in sleep associated with abnormal respiratory events. Occasional bursts of periodic limb movements noted, occasionally associated with arousal (PLM Index 79 / hr PLM Arousal Index 8/hr.

Interpretation. recommended pressure ipap 10 epap 6. Close clinical follow-up recommended to ensure the adequacy of titrated setting. Periodic limb movements, sever, of uncertain clinical significance. Reduced sleep efficiency likely due to sleep in the laboratory.
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I have no leg pains or weird feelings during the day and am not aware of any leg problems. I also am not aware of nighttime leg movements but obviously I make them. 79 an hour sounds like a lot to me!

My bipap machine was set at :
ABFLE
min 8
max 14
max ps 6
flex 3
That setting was achieved thru experimentation and help from this forum group in 2006. It seemed great and allowed 6 to 8 hours of sleep each night.

during the last 6 months my sleep has become more fragmented... hence the titration study.
The doctor's advice now is to change the settings to
min 7 (then go to 6 asap)
max 10
ps 4
His feeling is that I may be getting some of the arousals because the machine pressure is higher than I need.
After I had adjusted to the pressure change for a week,The doctor started me on Mirapex (0.125 mg... going to 0.25 after 5 days. So far I don't see any difference in hours of sleep although perhaps there is improvement in the number of awakenings after 2 a.m. I do see annoying side effects of congestion and lethargy. It is also harder to get back to sleep after the 5 or 6 awakenings during the night.

I have tried his settings. They seemed better when I changed the ps to 5. I have no idea what I am doing. This all has so many variables it is hard to know what you are achieving. What I do know is that I got more help from this forum when I started bipap than I ever did from the doctor or machine people. I am hoping some of you will again be able to interpret the test results and history and suggest a way to get more uninterrupted sleep.
Thanks for any input,
Laura

[Wulfman]

I'm not in a position to comment on your sleep study architecture, but will post some things that I've collected for your reading pleasure. If you do NOT have the software and card reader to monitor your nightly data, you REALLY need to get it. Otherwise, you're just taking shots in the dark.

Den


.

TYPE OF SLEEP

STAGE OF SLEEP

NREM Sleep

NREM sleep contributes to physical rest and may bolster the immune system.

Researchers often group NREM stages 3 and 4 together, calling them delta sleep.

Stage 1 (Light Sleep): A transitional stage between waking and sleeping, usually lasting 5 or 10 minutes. Breathing becomes slow and regular, the heart rate decreases, and the eyes exhibit slow rolling movements.

Stage 2 (True Sleep): A deeper stage of sleep where fragmented thoughts and images pass through the mind. Eye movements usually disappear, muscles relax, and there is very little body movement.

Stage 3 (Deep Sleep): A further deepening of sleep with additional slowing of heart and breathing rates.

Stage 4 (Deep Sleep): This is the deepest stage of sleep, in which arousal is the most difficult. Typically, sleep walking and bed wetting occur in this stage.

REM Sleep

REM sleep contributes to psychological rest and long-term emotional well-being. It may also bolster memory.

REM Stage (Dream Sleep): A dramatic decrease in muscle tone and an essential paralysis characterize this stage of sleep. Other characteristics are irregular breathing, increased heart rate, and rapid eye movements. The brain uses more oxygen, and the body stops regulating temperature. In this stage, people experience vivid, active dreams with complex symbols.


DEFINITIONS:
APNEA = cessation of airflow for 10 seconds or greater.
HYPOPNEA =>50% decrease in airflow for 10 seconds or greater with a decrease in oxygen saturation of >3%.
APNEA/HYPOPNEA INDEX (AHI) = apnea plus (+) HYPOPNEA/hour of sleep.
RESPIRATORY AROUSAL INDEX (RAI) = AHI +snoring related EEG arousals/hour of sleep.
AHI/RAI** Scale =<5 events /hour = (none); 5-15 events/hour = (mild); 15-30 events/hour = (moderate); >30 events/hour = (severe).
Respiratory related sleep fragmentation: Sleep arousals due to respiratory events or snoring.
Desaturation = Drop in O2 oximetry distribution saturation by 3% below average saturation.
SaO2 scale: >89%=(none); 85-89%=(mild);80-84%=(moderate); <80% (severe).
EPWORTH SLEEPINESS SCALE =<10=(does not indicate EDS (Excessive Daytime Somnolence));10-15=(indicates daytime somnolence-not excessive);>16 (indicates EDS).
RESPIRATORY EFFORT RELATED AROUSALS (RERAs)=Sleep Arousals due to respiratory events characterized by pressure flow limitations in the airflow indicator channel without significant O2 desaturations.
StageIII and StageIV are combined and referred to as Deep Sleep.
Sleep Efficiency = Normal is >80%

[ltd123]

Thanks for the information, Wulfman. As I understand it, the fact I have an emac computer means I can't get software for my Bipap machine. Has that changed?
Laura

[Wulfman]

Thanks for the information, Wulfman. As I understand it, the fact I have an emac computer means I can't get software for my Bipap machine. Has that changed?
Laura

Well, not really, but I THINK there are some that have used some alternative ways of getting a Windows environment to run on theirs. Maybe they'll drop in and make suggestions. I've avoided alternate operating systems......I've had enough to do just trying to keep up with all the stuff in the Windows world.

Den

[kteague]

Laura,

Hopefully those limb movements will soon be under control and you'll be sleeping sounder longer. Some people with PLMD don't feel any residual discomfort during the day, others do. If you don't, that's great. Aside from that there's no reason to feel leg discomfort during the day if you don't have RLS.

Knowing how much PLMD can disrupt sleep (and apparently 8 of your 79 per hour result in arousals) I wouldn't change pressures just due to poor sleep. Now, it's a different story if you wake up short of breath and heart beating fast - you could be having apneas. But the difficulty with treating OSA and PLMD at the same time is knowing which is causing the current problems. I've seen people chase the elusive good night's sleep by chasing pressures, masks, and machines while never addressing their diagnosed limb movements. You may find that once your medication for the movements is at a therapeutic level, your pressures will be fine.

Sorry I can't help you with bipap stuff - I have no experience with them.

Good luck with sorting this all out.

Kathy